Attention NC Residents

[NCgirl]

Okay guys, here we go again. We're the latest state in which the MDA's are trying to restrict our practice, as well as make it legal for AA's to work here. A bill is currently being introduced into the NC legislature titled "NC Anesthesia Patient Safety and Access Act." I don' t know all the details, but it's my basic understanding that the NCASA is trying to make it seem that we need more supervision, that anesthesia needs to be provided by someone whom they can have more control over. Their proposed solution is AA's. I know in other states it's hard to tell the difference b/t an AA and CRNA within an anesthesia dept. This act makes it seem as if MDA's will be constantly over an AA's shoulder. It attempts to call us as CRNA's unsafe, in not so many words. It also says there is a shortage of anesthesia providers, despite the fact we've increased to FIVE anesthesia schools in our state alone. This bill is a DIRECT ATTACK on our profession, and we will all regret it if it passes!!!

So here's what you need to do. If possible, visit or send a letter to your NC state representative and senator. (from your county or district). You can find this out by going to http://www.ncleg.net and either entering your zip code or voter's registration number. Once you find out who your legislator's are, at the VERY LEAST give them a call. Here is a sample of what to say:" Hello, my name is _______ and I am a CRNA (or CRNA student) in your voting district. I'm calling to ask that you NOT support the NC anesthesia pt safety and access act. My contact information is ______, and I would be happy to give you or your staff more information regarding this recently proposed bill."

Even if you're not into politics, just consider this: if this passes and AA's come into NC, we will no longer be in as much demand and your salary will eventually go down. Maybe money will motivate you to call if simply supporting the profession of nurse anesthesia isn't enough.

So, before all the AA's on here flame me, just chill out. This act basically says you guys are incompetent without an MDA holding your hand. Be pi**ed at me if you want, but I'm just trying to protect my future profession and career.

If anyone wants more info, visit the NCANA website. Thanks!

[Maxs]

I did not want to get into this, but JWK I am not going to let you in here with that mask on. I will unveil your peculiarity and then probably show what kind of spectator you maybe. Now your here defending MDA's but you were there and let these statements go without a comment.

Here I ran into medical students squabble the possibilities and the endanger of MDA's careers. In addition, here's how some medical students indeed feel.

" posted orginally on student doctor by: driverabu 08-19-2004 02:59 PM

Attention nitecrap, crna and all of you dipshts. Get the heck out of the MD forum and into your own. We chose to get our MDs and you chose to get your RN for whatever reason that may be. MDAs will always be worth more than CRNAs and that is final. Quit trying to throw in your crappy 2 cents worth to try and scare your future bosses (MDAs) and worry about holding your own. Bottom line, as a 4th year medical student, regardless of what you knuckle heads say, I am going into anesthesia because I love the field, I will make decent money and I will have a decent lifestyle. Did I say "cush?" NO, I said decent. You go ahead and make your 100-160 and I'll make my 200-250 and we'll both be happy. Quit trying to make yourselves feel more important than MDs because for one, you'll never be (although you all are a vital part of the medical team) and 2, the last I heard, an MD is superior to an RN. If it was sooooooo imperitive that you need to feel like you are at the top, you should have become an MD!!""

And I Know that JWK is in this cult. Don't get me wrong, but some of these students have positive attitudes towards CRNA's. The ones in this cult obviously don't.

""home many crnas can a gas doc supervise at one time? i'm a little confused about this aspect of the job. i cant really tell if this supervising role is a drawback or not. i know i definitely liked what the cardiac anesthesiologist did.""

As a matter of fact nobody (MDA's) offered an insight to this post."

" when Money talks, BullS**T (=CRNA) walks. " posted by leukocyte

for a minute I thought he was erythrocyte (red).

All this that is going is just a moot, you're right about that, but no one has a right to talk about anyone's back like that.

Maxs

[Maxs]

JWK I know you have nothing against CRNA's because I have seen your posts and you're a potential advocate for AA's, which is a professional courtesy. With that Said here is a post that gives an Isight and logical reasoning behind this blabblings.

Orginally posted by Tenesma:

""I finally throw in my view of things:

while I appreciate the fervor of some of the posters - it looks like you all have it wrong - and there is a serious misunderstanding both of the situation and of the issues....

It is not uncommon for this to be a BIG topic of discussion for pre-meds, medical students and residents early in their training... they hear all of these things about CRNAs, and the automatic response is to become defensive.

I hate to say this, but so far MacGyver actually has a good sense of what is going on with mid-level practitioners - and their possible effects on medicine and reimbursement as a whole.

So here are a few things to clear up any issues

1) CRNAs can practice independently of Anesthesiologists in ALL states ---- they can practice with a "physician" supervising in about 22 states, and in 33 states they can practice without any "physician" supervision at all.... and that "physician" supervision is primarily designed for them to be able to provide medications that they can't independently prescribe in those states....

---> So, in effect.... CRNAs can and do practice independently of physician supervision in most states. Don't confuse this with the "opt-out" rulings that have nothing to do with medical supervision, and are only designed to answer the question regarding Medicare Reimbursement.... one is a medical-legal issue the other is a billing issue

2) CRNAs provide great anesthesia services.... while I find the AANA's statement that they provide 65% of anesthetics to be misleading (cause in reality they only provide "independent" anesthesia in 30-35% of anesthetics around the country - based on Medicare Data)... but still, they provide great services - especially to rural areas, as well as to the armed forces where they outnumber MDAs by 50 to 1.

3) the argument of CRNA being equivalent to MDAs is an old issue - and most senior CRNAs (not the Student CRNAs or fresh out of school CRNAs who still don't have a clue) and most MDAs know that there is no equivalency. The act of administering anesthesia during a case can be done by both - and there is no data so far to show that a difference in outcomes (despite weak attempts on both sides). The act of administering anesthesia is based on a good understanding of physiology and pharmacology, and a lot of clinical experience... HECK, some of the best senior anesthesiologists I have worked with ONLY have a DDS degree and did a 2 year residency in the 60s.... but they have the clinical experience that would make your head spin.... So in the OR, we are highly trained technicians.... Just like anybody can be trained to do surgery (I know a Cardiac Surgery PA who opens the chest, takes down the LIMA, prepares the saphenous vein, and then assists with coronary anastomosis, then closes the chest --- that is a lot of stuff, considering that in academic programs ONLY the cardiac surgery fellow is ALLOWED to do that).... What makes a Surgeon a Surgeon isn't the operation, but knowing when to operate, knowing how to manage a patient pre-operatively, knowing how to manage complications post-operatively.... What makes a Surgeon a skilled Technician is exhaustive hands-on experience.... A similar analogy can be made as far as MDAs go, we are able to provide true peri-operative medicine - we can provide cardiac or medical clearance for a patient without requiring the surgeons to obtain extra consults for that patient - we play an extended role in the ICU, pain cliinic, pre-op. assessment clinic, PACU etc... In some areas and at some hospitals these things play a significant role and hence the continued demand for MDAs... In fact, if you look at the "opt-out" states where technically CRNAs can practice independently and bill medicare independently - MDAs still get great jobs and great pay for their added value to the hospital services and some of the cost savings they provide.

My prediction for the future: CRNAs will gain the right to bill Medicare independently in almost all states, they will form more and more of their own groups - heck they might even own the local surgi-center..... As anesthesia becomes safer and safer by the day, MDAs will become more and more Peri-operative physicians with further expansion of their skills into the ICU world... Especially with the Leapfrog studies pushing for dedicated intensivists in ICUs there will be a greater demand, and I wouldn't be surprised if over time ICU care will have better reimbursement than OR reimbursement.

So for those who say that we sold out the field.... I think there is some fallacy there. When no MDA was willing to work in rural Kansas, what are the surgeons or hospitals supposed to do? close their ORs?... the evolution of the CRNA was unavoidable... demand dictates care to some extent: in rural areas, FPs do c-sections, deliver babies and do appendectomies - they even run their own ICUS!!!!! in many rural areas, NPs and PAs are the only health care provider within 50 miles!!!

Yes, our salaries aren't the same compared to the 80s --- but that has to do with our weakness as effective negotiators/lobbyists with insurance companies/hospitals... A surgeon will get 1200-1400 dollars for a CABG and 30 days of post-op care (and that includes a possible take-back, opening the chest in the ICU at 3 am, etc...).... which is a HUGE cut from what they got in the early 80s (8-12,000 then)... Whereas Hospitals can still charge 60-90 dollars PER MINUTE for OR time - the hospital association lobbying group is HUGE and has not let the government/insurance companies bully them into lower reimbursement...

so for those who are going into anesthesia: it is a great field, with a lot of intellectual challenges, a lot of critical care, and very rewarding.... and once you are closer to being done with residency or actually practicing (like me or brachial plexus), then you will see what the difference is between an MDA and a CRNA."""

Maxs

[URgettingsleepy]

Here you go, Sorry but If I see a two face I have to call them out.

JWK posted on Studentdoctor.net

This in reference to CRNA's eventually adopting a clinical Doctorate model.

"Clinical doctorate or not, a CRNA will never be the equal to an MD, Professionally, legally, or otherwise"

JWK probably even shines the MD's shoes before they head out of work on a Friday night.

I wonder what he meant by "or otherwise"..

I took me about two seconds to find this post, now you can picture what this

TECHNICIAN really thinks. UR

[jwk]

Here you go, Sorry but If I see a two face I have to call them out.

JWK posted on Studentdoctor.net

This in reference to CRNA's eventually adopting a clinical Doctorate model.

"Clinical doctorate or not, a CRNA will never be the equal to an MD, Professionally, legally, or otherwise"

JWK probably even shines the MD's shoes before they head out of work on a Friday night.

I wonder what he meant by "or otherwise"..

I took me about two seconds to find this post, now you can picture what this

TECHNICIAN really thinks. UR

CRNA's won't be the equal of MD's. Not flaming - that's a simple fact.

[Sheri257]

Does anybody have the latest information on which states have accepted and/or banned AA's? And which states have legislation pending on this issue?

[jwk]

Does anybody have the latest information on which states have accepted and/or banned AA's? And which states have legislation pending on this issue?

Gee, all my old friends are back - Z, sleepy, lizz...:chuckle

[Maxs]

I thought we ended this CRNA vs MDA and his trailer debate.

THE END.

Maxs

[Nitecap]

SRNA student here and proud of it. Though JWK may rub some of you the wrong way I do look forward to his posts at times. They give us mostly acurate info on the profession which one day we will prob. be competing against fiercly. SO listen, learn, debate and try not to hate. This is a public forum and sometimes heated discussions b/t CRNA's, MDA's and AA's are the most imformative ones. I am on the studentdoctor.net debating and at times trash talking MDA residents, fellows and attendings frequently. Everybody just needs to chill and if you have this much motivation, energy and pride about your profession, use it the right way, send money to AANA/NCANA to assist them with theses legal battles.

peace out.

[Ted]

thread closed for a time out and moderator's discussion.

especially during heated discussions/debates, keep the focus on the topic and not your fellow bulletin board member. personal attacks are not tolerated on this bulletin board.